Walters v. UPMC Presbyterian Shadyside
187 A.3d 214 (2018)
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Rule of Law:
A healthcare facility that is a DEA registrant and discovers an employee diverting controlled substances owes a common-law duty to third parties to report the diversion to appropriate authorities, and a breach of this duty can lead to liability for subsequent harm the employee causes to patients at other facilities. However, a staffing agency that is not a DEA registrant does not owe a similar duty.
Facts:
- From March to May 2008, David Kwiatkowski worked as a radiology technician at UPMC Presbyterian Hospital ('UPMC'), placed there by his employer, Maxim Healthcare Services, Inc. ('Maxim').
- On May 7, 2008, a UPMC staff member observed Kwiatkowski steal a syringe of fentanyl, a controlled substance, and replace it with another syringe.
- Upon being confronted, Kwiatkowski was found with three empty fentanyl syringes on his person, and a search of his locker revealed a syringe labeled as morphine.
- A subsequent urine test confirmed that Kwiatkowski had fentanyl and opiates in his system.
- UPMC immediately terminated Kwiatkowski's access to the hospital.
- Two years later, in May 2010, Kwiatkowski was working at Hays Medical Center in Kansas.
- At the Kansas hospital, Kwiatkowski injected himself with fentanyl from preloaded syringes, refilled them with saline, and returned them for use on patients.
- Plaintiffs, who were patients at Hays Medical Center, contracted the same strain of hepatitis C that Kwiatkowski carried, allegedly from the contaminated syringes.
Procedural Posture:
- Plaintiffs filed negligence actions against UPMC and Maxim in a Pennsylvania trial court.
- UPMC and Maxim filed preliminary objections in the nature of demurrers, arguing they owed no legal duty to Plaintiffs.
- The trial court sustained the demurrers and dismissed all claims against UPMC and Maxim.
- Plaintiffs appealed to the Superior Court of Pennsylvania, an intermediate appellate court.
- The Superior Court reversed the trial court's order, holding that both UPMC and Maxim owed a common-law duty to report Kwiatkowski's conduct.
- UPMC and Maxim, as appellants, were granted allowance of appeal to the Supreme Court of Pennsylvania.
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Issue:
Does a healthcare facility or a health care staffing agency owe a common-law duty to protect unknown, future patients at other facilities by reporting an employee's criminal diversion of controlled substances?
Opinions:
Majority - Justice Wecht
Yes, as to UPMC, but No, as to Maxim. A healthcare facility registered with the DEA has a common-law duty to report an employee's diversion of controlled substances to protect third parties from foreseeable harm, but a non-registrant staffing agency does not share this duty. The court applied the five-factor Althaus test to determine whether to impose a new duty. For UPMC, the court found the public policy expressed in federal law (the Controlled Substances Act and its regulations), which requires DEA registrants to report diversions, weighed heavily in favor of a duty. The risk of grave, widespread harm was highly foreseeable, as an addicted technician was likely to repeat his dangerous conduct elsewhere. While acknowledging the potential for broad liability, the court concluded that the interest in protecting innocent patients from catastrophic harm outweighed the burden on UPMC, which was already obligated to report to the DEA. For Maxim, however, the court found no pre-existing statutory or regulatory duty to report. Imposing a generalized, common-law duty on Maxim to report to unspecified 'law enforcement' would be too amorphous and indeterminate, creating unbounded liability. Therefore, the public interest did not support extending the duty to a non-registrant staffing agency.
Dissenting - Chief Justice Saylor
No. Neither UPMC nor Maxim should be held to owe such a duty. The majority improperly uses the flexible Althaus test instead of the more specific framework of the Restatement (Second) of Torts § 286, which governs when a legislative or regulatory standard can be adopted in a tort case. Under that established framework, a regulation can only create a standard of care if it was designed to protect the specific class of persons to which the plaintiff belongs. The federal DEA reporting regulations were enacted to protect the general public's interest in controlling drug trafficking, not to protect a specific class of future patients in other states. By basing a state common-law duty on this federal regulation, the majority is essentially creating a negligence per se claim where none should exist and is expanding liability beyond principled limits.
Analysis:
This decision establishes a significant new common-law duty in Pennsylvania for healthcare providers that are DEA registrants, linking a federal regulatory violation to state tort liability for harm caused by a former employee to third parties. The court's holding carefully cabins this duty, refusing to extend it to entities like staffing agencies that lack a pre-existing, specific legal obligation to report, thereby avoiding the creation of an overly broad or amorphous duty. The case illustrates the judiciary's role in weighing complex public policy factors under the Althaus framework to adapt common law to modern risks, while also showing the tension between such flexible, policy-based analyses and more structured, rule-based approaches advocated by the dissent.
